The Australian & New Zealand journal of obstetrics & gynaecology
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Aust N Z J Obstet Gynaecol · Feb 2008
Randomized Controlled TrialProgesterone for maintenance tocolytic therapy after threatened preterm labour: a randomised controlled trial.
Women with preterm labour that is arrested with tocolytic therapy are at increased risk of recurrent preterm labour. The efficacy of maintenance tocolytic therapy after successful arrest of preterm labour remains controversial. ⋯ The use of vaginal progesterone suppository after successful parenteral tocolysis associated with a longer latency preceding delivery but failed to reduce the incidence of readmission for preterm labour.
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Aust N Z J Obstet Gynaecol · Feb 2008
Practice GuidelineGuidelines for the use of recombinant activated factor VII in massive obstetric haemorrhage.
Recombinant activated factor VII (rFVIIa) is emerging as a novel therapy for the treatment of life or fertility-threatening post-partum haemorrhage (PPH) unresponsive to standard therapy that in some cases may prevent the need for peripartum hysterectomy. The level of evidence to date for use of rFVIIa in PPH is limited to case reports and case series with one nonrandomised study. No high-quality randomised controlled trials have been published at this stage, precluding a quality systematic review. ⋯ A multidisciplinary group of Australian and New Zealand clinicians from the fields of obstetrics, anaesthesia and haematology, who have both clinical experience in and/or knowledge of rFVIIa was convened by the manufacturer. This group produced an opinion and guideline based on their experience and the published international literature on the use of rFVIIa. This is intended to be used as a guideline and algorithm for the use of rFVIIa, though any use should be tailored to local practice and resources.
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Aust N Z J Obstet Gynaecol · Feb 2008
ReviewVaricella and the pregnant woman: prevention and management.
Infection with varicella zoster virus (VZV) is often considered a childhood 'right of passage'; however, primary infection occurring in women of child-bearing age can have significant adverse consequences both for the mother and for her fetus. During the first trimester, primary VZV infection may result in stillbirth or a baby born with the stigmata of the congenital varicella syndrome, while infection in the peripartum period can result in neonatal varicella, which carries a significant mortality rate despite appropriate antiviral therapy. ⋯ Determining a woman's serostatus prior to pregnancy is advised, as effective vaccines are now available and should be administered to non-pregnant seronegative women of child-bearing age. Clinical practice guidelines for management of a pregnant woman exposed to VZV are presented.